Provider Demographics
NPI:1881232718
Name:NERI-HERNANDEZ, LUCERO (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:LUCERO
Middle Name:
Last Name:NERI-HERNANDEZ
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1655 PERRYTON DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75224-2449
Mailing Address - Country:US
Mailing Address - Phone:214-859-3504
Mailing Address - Fax:
Practice Address - Street 1:6363 FOREST PARK RD STE BL5.230
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-5479
Practice Address - Country:US
Practice Address - Phone:214-648-0102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2421103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst